Provider Demographics
NPI:1871352518
Name:INTEGRATIVE MOUNTAIN PSYCHIATRY LLC
Entity type:Organization
Organization Name:INTEGRATIVE MOUNTAIN PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:720-827-6801
Mailing Address - Street 1:#1070 1601 29TH ST.
Mailing Address - Street 2:SUITE 1292
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:720-364-8615
Mailing Address - Fax:
Practice Address - Street 1:#1070 1601 29TH ST.
Practice Address - Street 2:SUITE 1292
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1009
Practice Address - Country:US
Practice Address - Phone:720-827-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)